Common Side Effects of Immunizations

As the body responds to the immunization, some mild side effects might occur.   As long as they begin within two days of the injection, do not last longer than two days, and your child does not look ill, you can treat the symptoms as described below.

  • Fever > 101° – Approximately 1 in 3 children, may treat with acetaminophen (ibuprofen if > 6 months old) if uncomfortable.
  • Irritability – 1 in 3 children, may treat with acetaminophen.
  • Pain at the injection site – 1 in 4 children, massage or acetaminophen as necessary.
  • Redness at the injection site – 1 in 4 children, apply a warm cloth several times per day.
  • Swelling at the injection site – 1 in 4 children, *apply a warm cloth several times per day.
  • Tiredness – 1 in 10 children, no treatment necessary.

* With the 4th and 5th doses of DTaP, 1 in 30 children may get a swollen leg. We always give this shot on one of the legs. Although this can look worrisome, it will resolve without problems.  Call us if you are concerned.

Treating the Side Effects

We recommend using acetaminophen (Tylenol) to alleviate any discomfort or fever that might come after immunizations.  In children over 6 months, you can choose to use ibuprofen (Motrin and Advil) rather than acetaminophen.  You can safely follow the instructions on the box.  If you want to be safe and double check, the general dosing of Tylenol is 15mg per kg per dose or 7mg per pound per dose (2.2lbs = 1kg).  The dosing of Motrin is 10mg per kg per dose or 5mg per pound per dose.

Other Necessary Immunizations

Other than the immunizations listed in the Recommended Immunizations chart, the only other immunizations we recommend are as follows:

  • The flu vaccine should be given to any child older than six months, usually in September or October. This needs to be done yearly!  Please sign up for our newsletter on our website to know exactly when the flu vaccine is available.  We typically host four (or more) Saturday flu clinics every year.  The newsletter will also inform you of how many flu vaccinations your child will need.  The recommendations are constantly being updated and the newsletter is the best way to stay current.
  • If you are traveling out of the country, there may be other immunizations that you may need.

Immunizations for Future Pregnancies

Studies clearly show that the best protection against whooping cough and the flu for a newborn is for the mom to receive the Tdap and flu shot during pregnancy.

  • Per the CDC, the recommended time to get the Tdap shot is withEACH pregnancy during your 27th through 36th week of gestation, preferably during the earlier part of this time period. This replaces the original recommendation that pregnant women get the vaccine only if they had not previously received it
  • Per the CDC, the recommended time to get the flu shot (not nasal) is at any time during your pregnancy, regardless of the trimester.

Immunizations for Family and Caretakers of the Newborn Baby

It is important for surrounding family members and caretakers to receive certain vaccines in order to best protect the newborn infant until the baby can build up their own immune system. This is called herd immunity. We strongly recommend two immunizations in particular:

  • Tdap (whooping cough or pertussis) booster vaccine: Please have all adult family members and caretakers receive the Tdap vaccine as soon as possible. Siblings who are up to date with their immunization schedule should have excellent protection as we vaccinate all children against whooping cough. Your newborn baby will also receive this immunization at 2, 4, and 6 months of age; however, until 6 months of age the protection is not that strong. Blue Fish does NOT do adult Tdap immunizations; your primary care physician or local pharmacy is the best place to get this shot. See below for more details about the Tdap booster.
  • Influenza vaccine: All parents AND siblings should receive the flu vaccine as soon as it is available – typically in September or October. This vaccine needs to be done every year as the flu strains are constantly changing. Parents and siblings can receive their flu vaccines at Blue Fish. Please sign up for our newsletter on our website to know when the flu vaccine is available.

Pertussis or Whooping Cough Booster (Tdap Vaccine)

Experts estimate that up to one million cases of Pertussis (or whooping cough) occur each year in the United States, across all age groups.


  • Whooping cough is a serious infectious disease on the rise in the United States, across all age groups. According to the CDC, there were about 42,000 confirmed cases of whooping cough in 2012, the highest total since 1955. Of the 18 recorded whooping cough deaths in 2012, all but three were infants under the age of 1.
  • Whooping cough can be spread before symptoms appear.
  • Whooping cough can be tough to diagnose because early symptoms may appear like a cold or bronchitis. The classic symptom is a “whoop” – the sound of someone gasping for breath during a bad coughing spell. But you can have the infection without the “whoop.”
  • Whooping cough causes coughing spells that can affect breathing, eating, and sleeping. It can even lead to cracked ribs and hospitalization.
  • Protection against whooping cough from early childhood vaccines wears off. Adults and adolescents who have not received a booster vaccine are at risk for infection.
  • Adults and adolescents can spread whooping cough to infants who have not had all their vaccines. Babies are at greatest risk for serious complications, even death.

Protection against whooping cough does not last forever. The vaccination you received as a child wears off. Adults and adolescents should receive the whooping cough booster vaccine.

Blue Fish recommends that adults and adolescents receive a Tdap (this is a newer version of the previously recommended tetanus-diphtheria (Td shot) booster vaccine with added protection against whooping cough.) It is especially important for those in contact with infants younger than 6 months of age. Tdap can be administered regardless of when Td was last received.  Tdap was first available in the United States in 2005.  Ideally, Tdap should be given two weeks before beginning close contact with an infant.  Blue Fish offers the vaccine to all Blue Fish adolescent patients.  Parents should receive their booster from their primary care physician or local pharmacy as soon as possible.

Immunocompromised Patients

Children that have immunodeficiencies such as HIV or agammaglobulinemia require special considerations. These special guidelines also apply to children who are undergoing chemotherapy and as a result are immunocompromised as well. Not only do such patients have special immunization criteria but so do any family members with whom they reside. Live vaccines such as oral polio given to immunocompetent patients may be shed and affect immunocompromised individuals in contact with the immunized patients.

In general, immunocompromised patients cannot be given weakened live vaccines such as MMR, varicella, and the oral polio virus vaccine.

Traveling abroad

Traveling abroad can be a very enjoyable experience if planned for in advance. Each area of the world, however, presents unique medical challenges as there may be outbreaks of various illnesses not regularly seen in the United States. Additionally, access to good medical care and pharmaceutical agents may prove difficult. For this reason, we recommend letting us know as soon as possible when and where you are traveling so we may best prepare your child.

The best source of recommended vaccinations for travel is the following CDC (Center for Disease Control) web site: